Provider Demographics
NPI:1942202841
Name:PATEL, MAHESH I (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PINE VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2700
Mailing Address - Country:US
Mailing Address - Phone:973-822-7979
Mailing Address - Fax:
Practice Address - Street 1:205 S ESSEX AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3401
Practice Address - Country:US
Practice Address - Phone:973-678-6402
Practice Address - Fax:973-678-6443
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA40443173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA40443OtherMEDICAL LICENSE
NJ222749711OtherTAX ID #
NJ1667408Medicaid
NJ1667408Medicaid
NJ25MA40443OtherMEDICAL LICENSE
NJ222749711OtherTAX ID #